Pharmacoeconomic analysis of paliperidone palmitate for treating schizophrenia in Greece

Abstract

BackgroundPatients having chronic schizophrenia with frequent relapses and hospitalizations represent a great challenge, both clinically and financially. Risperidone long-acting injection (RIS-LAI) has been the main LAI atypical antipsychotic treatment in Greece. Paliperidone palmitate (PP-LAI) has recently been approved. It is dosed monthly, as opposed to biweekly for RIS-LAI, but such advantages have not yet been analysed in terms of economic evaluation.PurposeTo compare costs and outcomes of PP-LAI versus RIS-LAI in Greece.MethodsA cost-utility analysis was performed using a previously validated decision tree to model clinical pathways and costs over 1 year for stable patients started on either medication. Rates were taken from the literature. A local expert panel provided feedback on treatment patterns. All direct costs incurred by the national healthcare system were obtained from the literature and standard price lists; all were inflated to 2011 costs. Patient outcomes analyzed included average days with stable disease, numbers of hospitalizations, emergency room visits, and quality-adjusted life-years (QALYs).ResultsThe total annual healthcare cost with PP-LAI was €3529; patients experienced 325 days in remission and 0.840 QALY; 28% were hospitalized and 15% received emergency room treatment. With RIS-LAI, the cost was €3695, patients experienced 318.6 days in remission and 0.815 QALY; 33% were hospitalized and 17% received emergency room treatment. Thus, PP-LAI dominated RIS-LAI. Results were generally robust in sensitivity analyses with PP-LAI dominating in 74.6% of simulations. Results were sensitive to the price of PP-LAI.ConclusionsPP-LAI appears to be a cost-effective option for treating chronic schizophrenia in Greece compared with RIS-LAI since it results in savings to the health care system along with better patient outcomes.

Treatment continuation of four long-acting antipsychotic medications in the Netherlands and Belgium: A retrospective database study

“…Recent publications have shown PP1M to be either economically dominant (better effectiveness for lower cost) or cost effective [17,19,57–61] versus risperidone microspheres, olanzapine pamoate, haloperidol decanoate, zuclopentixol decanoate or a selection of oral antipsychotics.…”

Healthcare resource use in schizophrenia, EuroSC findings

“…Despite being developed in the US [26], the Lenert classification may be generalisable to the European population [28]. Indeed, the Lenert classification of HS and the corresponding utility weights have been used in a number of pharmacoeconomic analyses in European and non-European countries [29–34]. The present study provides estimates of resource use associated with schizophrenia management for each of the eight Lenert HS.…”

Cost-Utility Analysis of Depot Atypical Antipsychotics for Chronic Schizophrenia in Croatia

“…We therefore used a standard approach that had been used in previous analyses in Europe [25]. The decision tree produced expected outcomes for the average patient treated with average doses of each drug.…”

“…We adapted a previously validated decision tree [25] for use in Croatia, using input from clinical and administrative experts. Figure 1 depicts the model.…”

“…Risperidone LAI (RIS-LAI) was the first such drug [22], and has recently been joined by olanzapine LAI (OLZ-LAI) [23] and paliperidone LAI (PP-LAI) [24]. In another country undergoing economic change, a pharmacoeconomic analysis found that PP-LAI was costeffective when compared with RIS-LAI [25]. It is not currently known whether the outcomes would be similar in this country.…”